Key points

HIV-positive smokers have a greater risk of lung cancer than other smokers.

Tobacco is a legal, and
widely used, drug. About 9.6 million adults smoke in Great Britain. However,
smoking is addictive and there is clear evidence that it damages health in many
ways. Smoking is the main cause of preventable illness and death in the UK.
Every year, smoking causes around 96,000 deaths.

Smoking is a major risk
factor for cardiovascular
(heart) disease, causing about 14% of deaths from heart disease. It causes
around 80% of deaths from lung cancer and around 80% of deaths from chest
conditions such as bronchitis and emphysema. More than one quarter of all
cancer deaths are linked to smoking. These include cancer of the lung, mouth,
lip, throat, bladder, kidney, pancreas, stomach, liver and cervix.

Smoking can also affect
fertility, and damages your skin, teeth and sense of smell and taste.

Smoking and HIV

Smoking, in itself, does
not make HIV infection worse. The rate at which HIV disease progresses or the
number of CD4
cells lost is no greater in smokers than non-smokers.

However, there are higher levels of smoking
among people with HIV than in the general population, with the accompanying
health risks. For people taking HIV treatment who have an undetectable viral
load, smoking has a much greater impact on life expectancy than HIV infection.

It’s well known that
smoking increases the risk of heart disease,
high blood
pressure, and stroke.
There is evidence that smoking is the main risk factor for heart disease in
people with HIV. In addition, there is some evidence that having HIV may itself
increase the risk of heart disease. Further, some anti-HIV drugs can cause
increases in blood
fats, and this can contribute to cardiovascular illnesses. So if you smoke
and take certain anti-HIV drugs, your risks might be increased even further.

Stopping smoking

Stopping smoking (or not
starting in the first place) will significantly reduce your risk of developing
heart disease and other cardiovascular illnesses. Giving up, whatever age you
are, can improve your day-to-day health as well as potentially increasing your
life expectancy.

You are most likely to
stop smoking and stay stopped if you are motivated. There are lots of ways to
get help with giving up smoking.

Talk to your GP (family
doctor). Taking part in a ‘stop smoking’ clinic or service has been shown to
help people to stop smoking, and your GP can refer you to one of these. You can
take part in group or one-to-one support services. There are also online
support services available, and a telephone helpline (see below for details).

Cigarettes
are addictive because they contain nicotine. You may find that nicotine
replacement therapy can help reduce the craving for cigarettes and make
quitting easier. Your GP can prescribe patches, gum, or lozenges which contain
nicotine. There is no evidence that these interact with anti-HIV drugs. You can
also buy these over the counter.

Many people find that nicotine replacement therapy can help reduce the craving for cigarettes and make quitting easier.

More recently, electronic cigarettes (e-cigarettes)
have become a popular aid for stopping smoking. Evidence is still developing on
how effective they are, but many people have found them helpful for quitting. An
e-cigarette is a device that allows you to inhale nicotine without most of the
harmful effects of smoking (using one is often referred to as ’vaping’). The
effects of using e-cigarettes on your health aren’t fully known yet. However,
they are safer than smoking and may be a good option to use while you are
giving up, particularly if you have tried other methods without success. They
are not currently considered a medical device, so your GP cannot prescribe them
and you will need to buy them. This may change in the future.

Your GP
can prescribe medication to help you stop smoking, such as a drug called Champix. Champix (varenicline) is safe for people with HIV to use but, like
all drugs, has side-effects of its own. Talk to your doctor about whether Champix might be suitable for you.

The antidepressant drug
bupropion (Zyban) can also help you stop smoking. However, it interacts
with some anti-HIV drugs, especially ritonavir (Norvir, used to ‘boost’ other anti-HIV drugs) and efavirenz (Sustiva) – these drugs can reduce the
level of Zyban in your blood and you
may need to increase your dose. Talk to your HIV doctor if you are thinking
about taking bupropion so you can work out the best dose for you. The drug can
also cause side-effects, including dry mouth, insomnia, headaches, and fits.

Giving up smoking is hard. You are most likely
to give up if you get expert support. But there are things you can do,
alongside this, to help you with it. Avoiding ‘triggers’ – activities that you
associate with smoking – where possible, may help. Exercise can also be
helpful. Some people find that alternative therapies such as acupuncture and
hypnotherapy help them stop smoking.

Where to go for help and support

Find your nearest NHS
Stop Smoking Service from the NHS
Smokefree website, or call the Smokefree National Helpline to speak to a
trained adviser on 0300 123 1044.

Find out more

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.